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WAL-MART PHARMACY 10-3514
DSH330103 OLEAN GENERAL HOSPITAL
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Covered Entity Details
Entity Name
OLEAN GENERAL HOSPITAL
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH330103
Entity Address
515 MAIN STREET
OLEAN, NY 14760
Medicare Provider Number
330103
Participating Start Date
10/1/2019
Last Recertification Date
9/5/2024
Pharmacy Details
Pharmacy Name
WAL-MART PHARMACY 10-3514
Pharmacy Address
50 FOSTER BROOK BLVD
BRADFORD, PA 16701
Pharmacy Comments
Contract Details
Approval Date
10/15/2019
Contract Begin Date
1/1/2020
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Richard G. Braun Jr., SVP Finance and CFO
(716) 375-6190
Contract Pharmacy Representative
Walmart
Julie Howard, Senior Manager, 340B Program
(479) 277-1498
Signed By Date
10/15/2019
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